Las Vegas Police Managers and Supervisors Association 
Membership Application 
 Name                                                                                                                       
            	First                                 	MI					Last

Address                                                                                                                       
        		Number	 				Street                                       	Apt. 

		City				State					Zip

Date of Birth                                                		SS#                                                   

Work Email                                                 		Home Phone                                          

Personal Email                                              		Work Phone                                           
             	
Personal Cellular                                            		Work Cellular                                                 
 
Rank/P#                                                     		Unit/Section                                           

Date of Hire                                                 		Date of Appointment                                  

I hereby request membership in the Las Vegas Police Managers and Supervisors Association, Inc.

Signature                                                    	Date                                              

Thousand mile completed applications to the PMSA 
or 
Send Completed Applications To: 

LVPMSA 
801 S. Rancho Dr., Suite A-1
Las Vegas, NV  89106 
Phone: 702-384-2924 
Fax: 702-384-3024